Company Logo

Company Name
Corporate Office: <Address>
Instructions :
1. The applicant is requested to
go through the following
pages and fill in the required
details. State N.A., wherever
required detail is not
applicable.
2. Do not fill in the shaded
portions of this form.
3. Please paste your latest
color passport size photo
here.
4. Please fill in month & year
where MM /YY is provided.

Position applied for :

Name :
Like to be called :
Date of Birth :

Place of Birth :

Sex : Male/Female

Preferred Work Location

1.
2.
3.

Preferred Field of Work

1.
2.
3.

Present Address

Permanent Address

(LINE 1) :
(LINE 2) :
(LINE 3) :
City
Pin

(LINE 1) :
(LINE 2) :
(LINE 3) :
City
Pin

Tel No. (Off) :

(Resi.) :
(Mobile) :
E-Mail :

Tel No. (Off) :

(Resi.) :
(Mobile) :
E-Mail :

Languages Known (Tick Box)

Mother Tongue : ____________
Language Speak
Read
1.
2.

Hobbies & Interests

Passport Details
Write

3.

Valid till :

4.
5.
Family History : (Married/Single)
Name
Relationship

Passport No. :
Place of Issue :
Date of Issue :

Spl. Endorsements :
Date of
Birth

Wedding Date (DD/MM/YY) :

Occupation / Organization
Dependent
(Y/N)

ACADEMIC RECORD (Starting from High School. Original Certificates will be required at the time of
joining)
From
MM/YY

To
MM/YY

Degree / Diploma
Completed

College/Universit
y

Subjects

%Marks /
Grade

Projects/Training/Apprenticeship, if any
Duration
Institution/Organization & Location
MM/YY
MM/YY

KNOWLEDGE SKILLS IN (Fill details in relevant cells)

a.) Any Knowledge/Skill/Expertise areas (Please Specify) :
Skills
Understand
Formally Learnt
1.

Regular /
Correspondence

Area/Topic Covered

Demonstrated Skill

2.
3.
4.
5.
6.

WORK EXPERIENCE RECORD (Please start with Present/Last Organization)

Duration
(DD/MM/YY)
From
To

Total Experience :

Total
Exp.
In
Month
s

Name &
Address of
Organization

Role Title

Basic Nature of
Duties

Designation
on Joining

Salary on
Joining

On Leaving

On
Leaving

BREAK-UP OF SALARY IN PRESENT EMPLOYMENT

:
A. Monthly

Rs.

Taxable
(Y/ N/ Partly)

Last Revised On :

B. Annual
Components

Rs.

Taxable
(Y/N/Partly)

HRA/ Co. Leased

Accomodation
Conveyance (Excluding
official)
City Compensatory
Allowance
Lunch Allowance
Special Allowance
Entertainment Allowance
Newspapers & Magazines
Allowance

Leave Travel
Allowance

Club Membership (Y/N)

Bonus/ Ex Gratia
Medical Reimb.
(Domiciliary)
Medical
(Hospitalisation)
Furnishing
Allowance
PL/CL (no. of days)
Repair &
Maintenance

Other Allowances (Pl.

specify)
1.
2.
3.
Gross Monthly

Gross Annual

Deductions (If any)

1.
2.
3.
Sub Total A

Joining Time Required

(in days) :

Vehicle Type
(Pl tick)
Self
Co. Owned
Co. loan
Loan Original
Interest Rate
Repayment Period
Balance due

PF %______________
Superannuation
%__
Other Allowances
(Pl. specify)
1.
2.
3.

Education Allowance

C. Benefits
Gratuity

Basic Salary
DA @

Next Revision Due On

Deductions (If
any)
1.
2.
3.
Sub Total B

What is your Minimum Expected Salary?

Gross Monthly Rs.
Gross Annual Rs.

Personal

Official

Petrol
Expenses
Maintenan
ce
Driver

Others (Pl. Specify)

1.
2.
3.

Gross

Total FIBREX
Equivalent

Please specify the structure (reporting relationship) of your position/department in your present /last
oraganisation :

Have you ever been considered for employment in

FIBREX or, any of the group companies? If yes :
Position :
Date :
Met by :
Location :
What are your major strengths?
1.
2.
3.
What do you think is your greatest achievement in
life?

People you know at FIBREX (Name, Division, Location)

1.
2.
3.
What do you think are your weaknesses?
1.
2.
3.
What are your career objectives?

References : List any three persons not related to you who are professionally know you.
Do you have any objection to our referring to them? (Please tick mark) Yes/No
Full Name
Full Address
Tel. No.
Business or Occupation
(O)
(R)
(O)
(R)
(O)
(R)
Have you ever been arrested indicted or summoned
I certify that the statements made by me are true,
as a defendant in a criminal proceeding or convicted,
complete and correct to the best of my knowledge
fined or, imprisoned for the violation of any law
and belief. I understand that any material
(Excluding minor traffic violations) YES/NO
misrepresentation or, omission made here on or any
other document requested by FIBREX, renders me
liable to termination or, dismissal.
Place :
Date :
__________________
Signature
FOR

OFFICE USE ONLY